THE SENATE

S.B. NO.

1312

TWENTY-NINTH LEGISLATURE, 2017

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to the licensure of midwives.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.  The legislature finds that the nature of the maternity and prenatal services provided by midwives could potentially endanger the health and safety of women and newborns under a midwife's care if the profession is not adequately regulated.  Public health and safety concerns substantially outweigh any negative effects arising from regulation, including the resulting restrictions on individuals entering the profession of midwifery and any increase in the cost of midwifery services caused by regulation of the profession.  The legislature further finds that the auditor, in its sunrise analysis on the regulation of certified professional midwives, applied the criteria for licensure in the Hawaii regulatory licensing reform act.  The auditor recommended that the profession of midwifery be regulated and its practitioners be licensed.

     The purpose of this Act is to establish mandatory licensing for persons who engage in the practice of midwifery care.

     SECTION 2.  The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

midwives

     §   -1  Definitions.  As used in this chapter:

     "Accreditation Commission for Midwifery Education" means the organization established in 1982 and recognized by the United States Department of Education as an accrediting agency for midwifery education programs.

     "Board" means the state board of nursing established under section 457-3.

     "Client" means a person under the care of a licensed midwife, as well as the person's fetus and newborn child.

     "Licensed midwife" means an individual who holds a current license issued by the board pursuant to this chapter to engage in the practice of midwifery in Hawaii.

     "Midwife" means a person who engages in the practice of midwifery.

     "Midwifery Education Accreditation Council" means the organization established in 1991 and recognized by the United States Department of Education as an accrediting agency for midwifery education programs and institutions.

     "Out-of-hospital" means taking place in a birth center or home.

     "Postpartum period" means the period not exceeding six weeks from the date of delivery.

     "Practice of midwifery" means providing well-woman and maternity care for individuals and their newborns during the antepartum, intrapartum, and postpartum periods.

     §   -2  Powers and duties.  In addition to any other powers and duties authorized by law, the board shall:

     (1)  Receive applications for licensure;

     (2)  Determine the qualifications of persons applying for licensure;

     (3)  Grant licenses to qualified applicants;

     (4)  Establish procedures to renew, suspend, revoke, and reinstate licenses;

     (5)  Establish and collect fees for the examination of applicants for licensure and license renewal;

     (6)  Establish the minimum educational and continuing educational requirements for licensure;

     (7)  Investigate complaints against licensed midwives;

     (8)  Undertake, when appropriate, disciplinary hearings; and

     (9)  Subject to chapter 91, adopt, amend, or repeal rules, as necessary to effectuate this chapter.

     §   -3  Advisory committee; appointment; term.  (a)  The board shall appoint an advisory committee to serve as experts to the board in licensing matters.  The advisory committee shall consist of seven members as follows:

     (1)  The chair of the board, or the chair's designee, who shall be a nonvoting member;

     (2)  Four licensed midwives who shall be in current and active practice of midwifery in the State for the duration of their appointment and who shall have actively practiced as licensed midwives in the State for at least three years immediately preceding their appointment, who shall be voting members; provided that the four midwives initially appointed under this paragraph shall be as follows:

         (A)  Two certified professional midwives who shall be in current and active practice of midwifery in the State for the duration of their appointment and who shall have actively practiced as certified professional midwives in the State for at least three years immediately preceding their appointment, who shall be voting members; and

         (B)  Two certified nurse midwives who shall be in current and active practice of midwifery in the State for the duration of their appointment and who shall have actively practiced as certified nurse midwives in the State for at least three years immediately preceding their appointment, who shall be voting members;

     (3)  One licensed physician who has provided primary maternity care for at least twenty births in the twelve-month period prior to appointment, maintains current hospital privileges, and has attended at least one home birth, who shall be a nonvoting member; and

     (4)  One out-of-hospital birth consumer who is either currently under midwifery care and planning an out-of-hospital birth or has had an out-of-hospital birth in the past, who shall be a nonvoting member.

     (b)  Members of the committee shall serve four-year terms; provided that the initial members of the committee shall serve two-year terms; provided further that after June 30, 2017, members of the temporary advisory committee appointed under section 3 of Act    , Session Laws of Hawaii 2017, may continue in office as holdover members until their successors are appointed.

     (c)  In the event of the death, resignation, or removal of any committee member before the expiration of the member's term, the vacancy shall be filled for the unexpired portion of the term in the same manner as the original appointment.

     (d)  The committee shall elect a chairperson from among its members.  The committee shall meet at least annually to make recommendations to the board and may hold additional meetings at the call of the chairperson or at the written request of any two members of the committee.  Three voting members shall constitute a quorum.  The vote of the majority of members present at a meeting in which a quorum is present shall determine the action of the committee.

     §   -4  Scope of practice; formulary.  (a)  The board shall establish scope of practice standards for the practice of midwifery.

     (b)  The scope of practice standards shall include:

     (1)  Adoption of a drug formulary recommended by the advisory committee and approved by the board; and

     (2)  Practice standards for antepartum, intrapartum, postpartum, and newborn care that prohibit a licensed midwife from providing care for a client with a history of disorders, diagnoses, conditions, or symptoms outside of the scope of practice approved by the board.

     (c)  The scope of practice standards shall not:

     (1)  Require a licensed midwife to practice under the supervision of another health care provider, except as a condition imposed as a result of discipline by the board;

     (2)  Require a licensed midwife to enter into an agreement with another health care provider, except as a condition imposed as a result of discipline by the board;

     (3)  Impose distance or time restrictions on where a licensed midwife may practice;

     (4)  Grant a licensed midwife prescriptive privileges outside of the privilege of ordering, obtaining, and administering medications on the approved formulary; or

     (5)  Allow a licensed midwife to perform abortions.

     §   -5  License; qualifications.  (a)  No person shall engage in the practice of midwifery in this State unless the person holds a current license issued by the board pursuant to this chapter.  A license shall be granted to an applicant who files a board-approved application for licensure, pays the required application fees, and provides evidence to the board of the following:

     (1)  Completion of an educational program or pathway accredited by the Midwifery Education Accreditation Council or the Accreditation Commission for Midwifery Education;

     (2)  Documentation of a graduate letter from a school accredited by the Midwifery Education Accreditation Council or the Accreditation Commission for Midwifery Education or a letter of completion of portfolio evaluation process; and

     (3)  Successful completion of continuing education requirements.

     (b)  All licenses issued under this chapter shall be valid for two years from the date of issuance.

     §   -6  Fees; penalties.  (a)  Each applicant shall pay a licensing fee of $250 upon application for a new or renewal license.  Fees collected pursuant to this section shall be deposited into the compliance resolution fund established pursuant to section 26-9(o).

     (b)  Any fine imposed by the board after a hearing conducted pursuant to this chapter shall be no less than $100 and no more than $1,000 for the first violation.  A second or subsequent violation of this chapter shall be referred to the office of the attorney general for criminal prosecution.  Any person who pleads guilty to or is found guilty of a second or subsequent violation of this chapter shall be guilty of a misdemeanor.

     §   -7  Hearings.  (a)  Unless otherwise provided by law, in every case in which the board refuses to issue, renew, restore, or reinstate a license under this chapter, or proposes to take disciplinary action or other licensing sanctions against a licensee, the board shall conduct an administrative proceeding in accordance with chapter 91.

     (b)  In all proceedings before it, the board shall have the same powers respecting administering oaths, compelling the attendance of witnesses and the production of documentary evidence, and examining witnesses as are possessed by circuit courts.  In case of disobedience by any person of any order of the board, or of any subpoena issued by the board, or the refusal of any witness to testify to any matter regarding which the witness may be questioned lawfully, any circuit judge, on application by the board, shall compel obedience as in the case of disobedience of the requirements of a subpoena issued by a circuit court, or a refusal to testify therein.

     §   -8  Exemptions.  This chapter shall not apply to the following:

     (1)  Student midwives in training under the direct supervision of licensed midwives;

     (2)  A person administering care to a spouse or parent;

     (3)  A person rendering aid in an emergency where no fee for the service is contemplated, charged, or received; and

     (4)  A person performing a service within the person's authorized scope of practice of a profession that is licensed, certified, or registered under other laws of this State.

     §   -9  Client protection.  A licensed midwife shall not:

     (1)  Disregard a client's dignity or right to privacy as to the client's person, condition, possessions, or medical record;

     (2)  Breach any legal requirement of confidentiality with respect to a client, unless ordered by a court of law;

     (3)  Submit a birth certificate known by the licensed midwife to be false or fraudulent, or willfully make or file false or incomplete reports or records in the practice of midwifery;

     (4)  Fail to provide information sufficient to allow a client to give fully informed consent;

     (5)  Engage in the practice of midwifery while impaired because of the use of alcoholic beverages or drugs; or

     (6)  Violate any other standards of conduct as determined by the board.

     §   -10  Disclosure; record keeping.  (a)  Before initiating care, a licensed midwife shall obtain a signed informed consent agreement from each client.

     (b)  All licensed midwives shall maintain a record of signed informed consent agreements for each client pursuant to section 622-58.

     §   -11  Immunity from vicarious liability.  No licensed medical provider or facility providing medical care or treatment to a person due to an emergency arising during childbirth as a consequence of care received by a licensed midwife shall be held liable for any civil damages as a result of such medical care or treatment unless the damages result from the licensed medical provider or facility's provision of or failure to provide medical care or treatment under circumstances demonstrating a reckless disregard for the consequences so as to affect the life or health of another.  A physician who consults with a licensed midwife but who does not examine or treat a client of the midwife shall not be deemed to have created a physician-patient relationship with the client."

     SECTION 3.  (a)  There shall be established a temporary advisory committee to serve as experts to the board in midwife licensing matters.  The temporary advisory committee shall consist of seven members as follows:

     (1)  The chair of the board, or the chair's designee, who shall be a nonvoting member;

     (2)  Two certified professional midwives who shall be in current and active practice of midwifery in the State for the duration of their appointment and who shall have actively practiced as certified professional midwives in the State for at least three years immediately preceding their appointment, who shall be voting members;

     (3)  Two certified nurse midwives who shall be in current and active practice of midwifery in the State for the duration of their appointment and who shall have actively practiced as certified nurse midwives in the State for at least three years immediately preceding their appointment, who shall be voting members;

     (4)  One licensed physician who has provided primary maternity care for at least twenty births in the twelve-month period prior to appointment, maintains current hospital privileges, and has attended at least one home birth, who shall be a nonvoting member; and

     (5)  One out-of-hospital birth consumer who is either currently under midwifery care and planning an out-of-hospital birth or has had an out-of-hospital birth in the past, who shall be a nonvoting member.

     (b)  In the event of the death, resignation, or removal of any temporary advisory committee member before the expiration of the member's term, the vacancy shall be filled for the unexpired portion of the term in the same manner as the original appointment.

     (c)  The temporary advisory committee shall elect a chairperson from among its members.  The committee shall meet at least annually to make recommendations to the board and may hold additional meetings at the call of the chairperson or at the written request of any two members of the committee.  Three voting members shall constitute a quorum.  The vote of the majority of members present at a meeting in which a quorum is present shall determine the action of the committee.

     (d)  The temporary advisory committee shall submit annual reports to the legislature not later than twenty days prior to the convening of the regular sessions of 2018 and 2019.

     (e)  The temporary advisory committee shall cease to exist on June 30, 2019; provided that all members shall continue to serve as the initial members of the permanent advisory committee established under section    -3 in section 2 of the Act until their successors are appointed.

     SECTION 4.  If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of this Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.

     SECTION 5.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 6.  This Act shall take effect on July 1, 2019; provided that section 3 shall take effect on July 1, 2017.

 

INTRODUCED BY:

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Report Title:

Licensure; Midwife

 

Description:

Establishes mandatory licensing for midwives.  Effective 7/1/2019.  Establishes temporary advisory committee on midwife licensing until 7/1/19.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.